I have lived for long enough with POTS, EDS and my Chiari malformation to know that there is a direct correlation between how stressed I am and my symptoms. That is NOT saying that my conditions are caused by stress - just exacerbated. For me, travelling is a trigger for symptoms and relapses, so its a double whammy, because I get stressed travelling, then stressed when the symptoms come on. Anticipatory stress probably makes them worse too! It is this, the psychological battles you have with yourself daily when living with chronic illness, that I find the most stressful. I have gone from being someone who poo-pooed the mind-body connection to someone who experiences first-hand daily the impact of my thoughts on my physical health. My conditions are physical in origin - I have a medical folder full of notes and tilt table tests to prove that. But it is the psychological manifestations of these physical conditions that I have found the most debilitating. Stress, along with depression, anxiety and loss of confidence feature daily.

I get stressed when I can feel myself falling into another trough of the depression - I know its bad for me in the same way it is bad for even healthy people (all those studies about cancer and heart disease...) but I get stressed because I know it increases my susceptible to relapses (my tolerance of triggers drops). I get stressed because I try to avoid those pits, yet despite all the CBT (cognitive behaviour therapy), counselling and all my other self-management techniques, I still find myself there from time to time.

The saying goes "identifying the problem is half way there", and with my Expert Patient Programme tutor hat on, I know that identifying the problem is the first of the problem solving steps. But I am learning that the identification is the easy half and easy step it seems!

Unlike things that have caused my stress before (exams, university, exams, relationships, exams), my long-term health conditions are not (unfortunately) going to go away. This means I actually have to deal with how I react to the cause of the stress - my illnesses. Step 2. The other important things I try and remember are as follows:

Lots of people get stressed in the land of the healthy too

It is normal to experience some stress because of my situation, so accept that and allow yourself to be stressed/sad/whatever other emotion you may be feeling. My favourite term for this I heard on Twitter recently is a "pity party" - go on, and throw yourself a little one for an hour or so, then . . .

I find writing manageable to-do lists really helps, for the next hour or day just to get me doing things

Autogenics is a relaxation technique I have found to be really helpful, along with the Alexander Technique for calming me down and centring myself.

I think this quote from Bruce Lee (martial arts) is appropriate here:

"Do not pray for an easy life, pray for the strength to endure a difficult one"

For spoonies out there, I think we need it modified to say "the motivation and determination to practice and implement these coping strategies..."

Life is always going to involve some stress - the stressful thing about life with chronic illness is that stress is both greater and has a worse effect on our health. That is a double whammy and a half to get stressed about! I better be off to do some Autogenics then....